BlueSelect Silver Classic – PPO
94% cost sharing reduction [Popular Plan]
Network type: PPO
Coverage tier: Silver
Primary care visit: $10 copay, 40% coinsurance
Specialist visit: 40% coinsurance
Urgent care visit: 40% coinsurance
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | PPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $800 per person $1,600 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $10 copay, 40% coinsurance |
| Specialist visit | 40% coinsurance |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 40% coinsurance |
| Emergency room | 40% coinsurance |
| Ambulance | 40% coinsurance |
| Hospital stay (facility) | 40% coinsurance |
| Hospital stay (physician) | 40% coinsurance |
| Outpatient procedure (facility) | 40% coinsurance |
| Outpatient procedure (physician) | 40% coinsurance |
| Physical rehabilitation | 40% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 40% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $1 copay |
| Brand | $10 copay |
| Non-preferred Brand | 40% coinsurance |
| Specialty | 40% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 40% coinsurance |
| Imaging (CT/PET/MRI) | 40% coinsurance |
| Blood work | 40% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 40% coinsurance |
| Psychiatric hospital stay | 40% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://shop.yourwyoblue.com/content/sbcs/2024/WY/Individual/BlueSelectSilverClassic94.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_WY_4T_HealthInsuranceMarketplaceBlueSelect.pdf |
| Search doctor list | https://bcbswy.sapphirecareselect.com |
